ICD-10-CM: Adverse Effects, Poisoning, …

1 ICD-10-CM: Adverse Effects, poisoning , underdosing and toxic Effects T36-T65 2015 Anthelio Healthcare Solutions Inc. Proprietary and confidential. All Rights ICD-10 ExpressLearnJune 09, 2015In ICD-10-CM, coding of Adverse effects, poisonings and toxic effects is nothing new, although often times defining the differences can be confusing, making the coding more difficult. underdosing , however, is a new concept in ICD-10-CM and the coding guidelines associated with this condition are very review of the Guidelines helps clarify these concepts. We ll start with the overview: ICD-10-CM Official Guidelines for Coding and Reporting FY 2015 I., C., 19., e Adverse Effects, poisoning , underdosing and toxic EffectsCodes in categories T36-T65 are combination codes that include the substance that was taken as well as the intent.

2 No additional external cause code is required for poisonings, toxic effects, Adverse effects and underdosing codes. Do not code directly from the Table of Drugs and Chemicals. Always refer back to the Tabular List. Use as many codes as necessary to describe completely all drugs, medicinal or biological substances. If the same code would describe the causative agent for more than one Adverse reaction, poisoning , toxic effect or underdosing , assign the code only once. If two or more drugs, medicinal or biological substances are reported, code each individually unless a combination code is listed in the Table of Drugs and let s look specifically at each of the effect ICD-10-CM Official Guidelines for Coding and Reporting FY 2015I.

3 , C., 19., e., 5., (a) Adverse EffectWhen coding an Adverse effect of a drug that has been correctly prescribed and properly administered, assign the appropriate code for the nature of the Adverse effect followed by the appropriate code for the Adverse effect of the drug (T36-T50). The code for the drug should have a 5th or 6th character 5 (for example ) .Examples of the nature of an Adverse effect are tachycardia, delirium, gastrointestinal hemorrhaging, vomiting, hypokalemia, hepatitis, renal failure, or respiratory we have been given directions on how to determine if there has been and Adverse effect and the sequencing of the codes, let s practice. We will only work through the Adverse effect EffectScenario: Hematuria due to Coumadin, taken as prescribed, for atrial needs to be coded?

4 1. Hematuria which is the Adverse effect of the medication 2. Adverse effect of Coumadin, the drug was taken as prescribed 3. Atrial fibrillation, the original condition being treated Adverse effect of Coumadin, the drug was taken as prescribedPoisoning ICD-10-CM Official Guidelines for Coding and Reporting FY 2015 I., C., 19., e., 5., (b) PoisoningWhen coding a poisoning or reaction to the improper use of a medication ( , overdose, wrong substance given or taken in error, wrong route of administration), first assign the appropriate code from categories T36-T50. The poisoning codes have an associated intent as their 5th or 6th character (accidental, intentional self-harm, assault and undetermined. Use additional code(s) for all manifestations of poisonings.)

5 If there is also a diagnosis of abuse or dependence of the substance, the abuse or dependence is assigned as an additional of poisoning include: Errors made in drug prescription or in the administration of the drug by provider, nurse, patient, or other person. If an overdose of a drug was intentionally taken or administered and resulted in drug toxicity, it would be coded as a poisoning . If a nonprescribed drug or medicinal agent was taken in combination with a correctly prescribed and properly administered drug, any drug toxicity or other reaction resulting from the interaction of the two drugs would be classified as a poisoning . When a reaction results from the interaction of a drug(s) and alcohol, this would be classified as we have been given directions on how to determine if a poisoning has occurred and the sequencing of the codes, let s practice.

6 We will only work through the poisoning : A toddler is seen in the emergency department with stomach pain and diarrhea after swallowing several Aleve found in his grandmother s needs to be coded? 1. poisoning by Aleve 2. Stomach pain, manifestation of poisoning 3. Diarrhea, manifestation of poisoning by Aleve 14 ICD-10-CM TABLE of DRUGS and CHEMICALSS ubstancePoisoning,Accidental(unintention al) Poisoning, Intentionalself-harmPoisoni ng,AssaultPoisoning, TabularT45 poisoning by, Adverse effect of and underdosing of primarily systemic and hematological agents, not else where classifiedThe appropriate 7th character is to be added to each code from category T45A - intial encounterD - subsequent encounterS - poisoning by, Adverse effect of and underdosing of anticoagulants and antithrombotic drugs poisoning by, Adverse effect of and underdosing of anticoagulants Adverse effect of anticoagulantsUnderdosing ICD-10-CM Official Guidelines for Coding and Reporting FY 2015 I.

7 , C., 19., e., 5., (c) UnderdosingUnderdosing refers to taking less of a medication than is prescribed by a provider or a manufacturer s instruction. For underdosing , assign the code from categories T36-T50 (fifth or sixth character 6 ). Codes for underdosing should never be assigned as principal or first-listed codes. If a patient has a relapse or exacerbation of the medical condition for which the drug is prescribed because of the reduction in dose, then the medical condition itself should be coded. Noncompliance ( , ) or complication of care ( ) codes are to be used with an underdosing code to indicate intent, if have been given an understanding of what constitutes underdosing and the sequencing of the codes, let s practice.

8 We will only work through the underdosing : 85 year-old presents with acute exacerbation of his chronic systolic heart failure due only taking half of his Lasix prescription. He states he doesn t want to have to get up at night to needs to be coded? 1. Acute on chronic systolic heart failure 2. underdosing of Lasix 3. Noncompliance with medication of Lasix Effects ICD-10-CM Official Guidelines for Coding and Reporting FY 2015I., C., 19., e., 5., (c) toxic EffectsWhen a harmful substance is ingested or comes in contact with a person, this is classified as a toxic effect . The toxic effect codes are in categories T51-T65. toxic effect codes have an associated intent: accidental, intentional self-harm, assault and : toxic effects are of substances chiefly nonmedicinal as to source toxic effects should be sequenced first, followed by all manifestations When no intent is indicated code to accidental.

9 Undetermined intent is only for use when there is specific documentation in the record that the intent of the toxic effect cannot be s put into practice what we have learned about what a toxic effect is and how to sequence the codes. We will only work through the toxic effects Effects Scenario: 37 year old presents with dizziness and nausea as toxic effects of prolonged exposure to natural gas fumes from a hot water heater supply hose needs to be coded? 1. toxic effect of natural gas fumes 2. Dizziness R42 3. Nausea effect of natural gas fumes TABLE of DRUGS and CHEMICALSS ubstancePoisoning,Accidental(unintention al) Poisoning, Intentionalself-harmPoisoni ng,AssaultPoisoning,UndeterminedAdversee ffectUnderdosingAleve-see TabularT39 poisoning by, Adverse effect of and underdosing of nonopioid analgesics, antipyretics and antirheumaticsThe appropriate 7th character is to be added to each code from category T39A - intial encounterD - subsequent encounterS - poisoning by, Adverse effect of and underdosing of other nonsteroidal anti-inflammatory drugs[NSAID] poisoning by, Adverse effect of and underdosing of propionic acid derivaties poisoning by propionic acid derivatives, accidental (unintentional)

10 ICD-10-CM TABLE of DRUGS and CHEMICALSS ubstancePoisoning,Accidental(unintention al) Poisoning, Intentionalself-harmPoisoni ng,AssaultPoisoning, TabularT50 poisoning by, Adverse effect of and underdosing of diuretics and other and unspecified drugs, medicamentsand biological substancesThe appropriate 7th character is to be added to each code from category T50A - intial encounterD - subsequent encounterS - poisoning by, Adverse effect of and underdosing of loop [high-ceiling] diuretics poisoning by, Adverse effect of and underdosing of loop [high-celing] diuretics underdosing of loop [high-ceiling] diureticsICD-10-CM TABLE of DRUGS and CHEMICALSS ubstancePoisoning,Accidental(unintention al) Poisoning, Intentionalself-harmPoisoni ng,AssaultPoisoning, TabularT59 toxic effort of other gases, fumes and vaporsincludes: aerosol propellantsExcludes1: chlorofluorocarbons ( )The appropriate 7th character is to be added to each code from category T59A - intial encounterD - subsequent encounterS - toxic effect of other specified gases, fumes and vapors toxic effect of other specified gases, fumes and vapors toxic effect of other specified gases, fumes and vapors, accidental (unintentional)